Anaesthesia and Intensive Care最新文献

{"title":"Improving the efficiency of sevoflurane delivery during general anaesthesia by educating and motivating anaesthetists to utilise the Volatile Efficiency Ratio.","authors":"Samuel T Costello, Blake J Vorias, Roman Kluger","doi":"10.1177/0310057X241296574","DOIUrl":"10.1177/0310057X241296574","url":null,"abstract":"<p><p>Volatile anaesthetic agents such as sevoflurane contribute to greenhouse gas emissions, and selecting low fresh gas flows on anaesthetic machines minimises their waste. Facilitating improvements in sevoflurane use requires the education, motivation, and standardised evaluation of anaesthetists. There is currently no standard of practice related to the efficiency of anaesthetic gas delivery per case. We conducted a multi-component study termed 'Low With The Flow' (LWTF) to directly address these requirements by educating and motivating anaesthetists to reduce fresh gas flow and thereby sevoflurane use. We introduced a novel metric, the 'volatile efficiency ratio' (VER), able to be calculated on Draeger Primus™, the Draeger Atlan™ family and Draeger Perseus A500™ machines, to audit sevoflurane use in a case-by-case fashion, and assess whether the intervention could achieve a set VER target. The LWTF intervention significantly improved the efficiency of sevoflurane delivery (VER 0.46 pre-intervention (<i>n</i> = 518) versus VER 0.57 post-intervention (<i>n</i> = 531), 95% confidence interval 0.092 to 0.129, <i>P < </i>0.0001) resulting in a calculated average of 1.3 kg carbon dioxide equivalent emissions reduction and approximately AUD 3.50 saving per case. Consequently, the financial and environmental outcomes from sevoflurane delivery were considerably reduced. Our LWTF intervention provides a valuable model for other anaesthetic departments to investigate and address the global environmental and financial burdens related to their volatile anaesthetic use. For anaesthetists using anaesthesia machines that do not facilitate calculation of VER, an approach using components of our LWTF intervention may still reduce the environmental and financial impacts associated with administration of volatile anaesthesia.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"161-170"},"PeriodicalIF":1.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The validity of self-reported smoking status on day of surgery in a mixed elective surgery population.","authors":"Sara B Urquhart, Gemma I Webb, Samuel Leong, Ashley R Webb","doi":"10.1177/0310057X251315764","DOIUrl":"https://doi.org/10.1177/0310057X251315764","url":null,"abstract":"<p><p>Rates of misrepresenting smoking status on day of surgery varies with the clinical context. In perioperative smoking cessation trials, participants in the intervention group might be more likely to provide untruthful data about quitting when they have received substantial quit support but continued to smoke. The objective of this study was to determine misrepresentation rates of smoking status on day of surgery in mixed elective surgical populations, comparing groups offered or not offered additional cessation support. We undertook a post hoc analysis of data from three published randomised trials at a Melbourne public hospital that incorporated interventions during the wait-list period aimed at increasing smoking cessation. Participants were smokers (<i>n</i> = 1413) who were randomised to minimal cessation help at wait-listing (control group) or significant assistance, for example, mailed nicotine replacement (intervention group). Quit by day of surgery claims were verified by exhaled carbon monoxide (true cessation <8 parts per million). Verified cessation (>24 h) before surgery occurred in 161/1413 (11.4%) while 44/1413 (3.1%) misrepresented quitting. Continued smoking was in 1208/1413 (85.5%). Misrepresentations were higher in the intervention/offer of help groups (4.1%) than control groups (1.7%) (odds ratio (OR) 2.46, 95% confidence interval (CI) 1.17 to 5.63, <i>P</i> = 0.012). Offering cessation help increased quitting odds by 77%, (OR 1.77, 95% CI 1.24 to 2.52, <i>P</i> = 0.002). In contrast to other studies, we found group allocation in cessation trial settings had a significant effect on misrepresentation risk. The implication of this is that biochemical verification of quit status is essential in trial contexts for accurate data collection and to prevent misclassification bias.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251315764"},"PeriodicalIF":1.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"James Young Simpson's <i>Notice of a New Anaesthetic Agent</i>: The first pamphlet on chloroform.","authors":"Rajesh P Haridas","doi":"10.1177/0310057X241285167","DOIUrl":"https://doi.org/10.1177/0310057X241285167","url":null,"abstract":"<p><p>James Young Simpson's <i>Notice of a New Anaesthetic Agent</i> is a rare pamphlet of which three copies have hitherto been documented. Two of the three known copies were inscribed by Simpson with the words 'proof copy'. A fourth copy of the pamphlet, also inscribed with the words 'proof copy', has been identified. Although regarded by Simpson as a proof copy, there is previously unreported evidence that the pamphlet was advertised by the publisher on 12 November 1847, published on 13 November 1847, and sold on that day by booksellers in Edinburgh. Thus, the <i>Notice</i> pamphlet was the first published report of the use of chloroform as an anaesthetic agent. The pamphlet was issued 2 or 3 days before the well-known revised edition bearing the title <i>Account of a New Anaesthetic Agent</i>, and one week before the publication of Simpson's papers on chloroform in <i>The Lancet</i> and the <i>Medical Times</i>.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X241285167"},"PeriodicalIF":1.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two episodes of delayed emergence in a healthy young man.","authors":"James R Nielsen, Anil Keshava","doi":"10.1177/0310057X241275126","DOIUrl":"10.1177/0310057X241275126","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"136-138"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The physiologists who 'oxygenised' sport.","authors":"Peter J Featherstone, Christine M Ball","doi":"10.1177/0310057X241311823","DOIUrl":"10.1177/0310057X241311823","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"80-82"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A feasibility study of measuring maternal anaemia and postoperative outcomes after caesarean section.","authors":"Mark O'Donnell, Alicia T Dennis","doi":"10.1177/0310057X241275127","DOIUrl":"10.1177/0310057X241275127","url":null,"abstract":"<p><p>SummaryIron-deficiency anaemia (IDA) is a global health problem. The impact of IDA on outcomes in obstetric patients who undergo caesarean section (CS) is unknown. We assessed the feasibility of conducting a large study to investigate perioperative anaemia and outcomes after CS. With ethics approval and trial registration, 60 obstetric patients (30 planned CS, 30 emergency CS) were included. Feasibility categories were willingness to participate in a study, to undergo additional blood tests (haemoglobin, ferritin), to have weight measured and to undertake quality of recovery (QoR) questionnaires. Of eligible people approached, 100% agreed to participate and 100% would participate in a future study. Ninety percent (95% confidence interval (CI) 82.4% to 97.6%) and 83% (95% CI 73.9% to 92.7%) agreed to additional tests in hospital and after discharge, respectively. Ninety-eight per cent (95% CI 95.1% to 100%) consented to being weighed, and 100% completed QoR questionnaires. Preoperatively, 8.5% (95% CI 1.4% to 15.6%) of participants were anaemic. Postoperative haemoglobin was measured in only 22 (36.7%, 95% CI 24.5% to 48.9%) participants, and 40.9% (95% CI 20.4% to 61.5%) were anaemic, suggesting at least a quadrupling of the proportion of anaemic patients from pre- to postoperatively. Ferritin was not measured postoperatively in any participant. The prevalence of participants discharged with IDA was unquantifiable. Postoperative IDA in obstetric patients is likely to be a serious problem that is currently unrecognised. Our data suggest that a definitive study to determine associations between maternal anaemia and perioperative outcomes after CS surgery is feasible.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"92-102"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mimicking the Eleveld propofol target-controlled infusion model using the Marsh model with weight adjustment in a super-obese patient.","authors":"George Zhong, Sarah J Wong","doi":"10.1177/0310057X241275122","DOIUrl":"10.1177/0310057X241275122","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"139-141"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of type of anaesthetic on delirium after surgery for acute hip fracture: An instrumental variable analysis to assess causation.","authors":"Anna-Marie G Tanios, Emily L Gallagher, Michael S McManus, John A Riordan, Ian A Harris, Lara A Harvey","doi":"10.1177/0310057X241275116","DOIUrl":"10.1177/0310057X241275116","url":null,"abstract":"<p><p>Delirium is the most common in-hospital complication affecting older adults with acute hip fractures. Current evidence demonstrates inconsistent associations between anaesthetic type for acute hip fracture surgery and postoperative delirium. Using the Australian and New Zealand Hip Fracture Registry database, we conducted a retrospective cohort study of patients aged 50 years and over who underwent acute hip fracture surgery between 2015 and 2020. The incidence of delirium in patients who received general anaesthesia alone or combined with a regional technique, versus those who received spinal or regional anaesthesia was assessed. Multivariable multilevel logistic regression was used to test associations between anaesthetic type and delirium controlling for known confounders. Finally, given hospital variation in preference for anaesthetic type, an instrumental variable analysis was performed to include the effect of both known and unknown confounding. Of 35,252 patients, 25,682 (72.9%) patients received general anaesthesia, and 9570 (27.2%) patients received spinal or regional anaesthesia for their hip fracture surgery. A higher proportion of patients who received general anaesthesia developed delirium than those who received spinal or regional anaesthesia (40.6% vs. 35.7%, odds ratio (OR) 1.23, 95% confidence intervals (CI) 1.18 to 1.30, <i>P</i> < 0.0001). After adjusting for known confounders, general anaesthesia patients were at slightly increased odds of developing delirium (OR 1.14, 95% CI 1.04 to 1.25, <i>P</i> = 0.0052). However, the instrumental variable analysis found no statistically significant difference between groups (OR 1.03, 95% CI 0.99 to 1.07, <i>P</i> = 0.141). Therefore, while a weak association was found between general anaesthesia exposure and postoperative delirium, an instrumental variable analysis to compensate for unmeasured confounding showed no causal association between general anaesthesia and postoperative delirium.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"116-124"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with poor intraoperative perfusion and postoperative complications in otolaryngological autologous tissue transfers: A single-centre retrospective observational study.","authors":"Steven C Eastlack, Adriano A Bellotti, Wesley H Stepp, Joshua B Cadwell, Alan M Smeltz","doi":"10.1177/0310057X241275112","DOIUrl":"10.1177/0310057X241275112","url":null,"abstract":"<p><p>The purpose of this study was to identify haemodynamic factors that are associated with tissue hypoperfusion in flap/graft surgical patients that might be modified to reduce perioperative morbidity. We conducted a single-centre, retrospective, observational study of 1355 patients undergoing head and neck flap reconstructions. Logistic regression and chi-square analyses were employed to identify factors which signal perioperative complications. Study endpoints included postoperative lactic acidosis, acute kidney injury (AKI) and early surgical flap revision surgery. Intraoperative data were collected as time-weighted averages of the haemodynamic variables, including pulse pressure variation (PPV), mean arterial pressure, and vasopressor doses. Cumulative volume was used for intravenous (IV) fluids. Relevant patient comorbidities were also included in the analysis. The most common complication was hyperlactataemia (22.9%), followed by AKI (14.1%) and take-back surgery (3.3%). No patient factors were significantly correlated with flap complications. Elevated max PPV was significantly associated with elevated lactate and AKI in univariate regression, but only AKI in the multivariate analysis (<i>P</i> = 0.003). Case duration was the only variable associated with take-back surgery in the multivariate regression (<i>P</i> = 0.007); it was also associated with lactic acidosis (<i>P</i> = 0.003). Neither IV fluid administration nor the use of vasopressors appeared to be associated with study outcomes in the multivariate analysis.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"83-91"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibreoptic intubation in children and young people in resource-limited settings: A case series during a humanitarian aid operation in Guinea.","authors":"Raphael Laurent, Eva Kardous, Oumar R Diallo, Charles Collet, Hervé Benateau, René Allary, Florent Baudin","doi":"10.1177/0310057X241272111","DOIUrl":"10.1177/0310057X241272111","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"142-144"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}